ABSTRACT
BACKGROUND: Systemic therapeutic management of post-transplant Kaposi sarcoma (KS) is mainly based on 3 axes: reduction of immunosuppression, conversion to mammalian target of rapamycin (mTOR) inhibitors, chemotherapy, or a combination of these. OBJECTIVE: To obtain an overview of clinical strategies about the current treatment of KS. METHODS: We conducted a multicenter retrospective cohort study including 145 solid organ transplant recipients diagnosed with KS between 1985 and 2011 to collect data regarding first-line treatment and response at 6 months. RESULTS: Overall, 95%, 28%, and 16% of patients had reduction of immunosuppression, conversion to mTOR inhibitor, and chemotherapy, respectively. Patients treated with chemotherapy or mTOR inhibitor conversion were more likely to have visceral KS. At 6 months, 83% of patients had response, including 40% complete responses. LIMITATIONS: The retrospective design of the study. CONCLUSION: Currently available therapeutic options seem to be effective to control KS in most patients. Tapering down the immunosuppressive regimen remains the cornerstone of KS management.
Subject(s)
Antineoplastic Agents/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Immunosuppressive Agents/administration & dosage , Organ Transplantation/adverse effects , Sarcoma, Kaposi/therapy , Skin Neoplasms/therapy , Adult , Drug Substitution , Europe , Female , Graft Survival , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Retrospective Studies , Sarcoma, Kaposi/etiology , Sirolimus/therapeutic use , Skin Neoplasms/etiology , Survival Rate , TOR Serine-Threonine Kinases/antagonists & inhibitors , Tacrolimus/therapeutic useABSTRACT
BACKGROUND: The increased risk of skin cancer is well known in heart and kidney transplant recipients, but fewer data exist on liver-transplant recipients (LTRs). The aim of this study was to analyze the prevalence, clinical features and risk factors of skin cancers in LTR treated mainly with tacrolimus. METHODS: We selected LTR grafted in our hospital between January 1996 and December 2008, aged 20 years or more at the time of the study. Data were collected from the patients' medical files and with a questionnaire. RESULTS: Three hundred seventy-one LTR were included. The median follow-up period was 8.2 years. The overall prevalence of skin cancers was 13.5%. The prevalence of melanoma was 1.3%. The squamous cell carcinoma to basal cell carcinoma ratio was 1:3. Both the overall cumulative patient risk of de novo skin malignancies and the squamous cell carcinoma-to-basal cell carcinoma ratio increased with time postgraft. The duration of immunosuppression was a risk factor, in addition to those common in the general population. No association was found between the primary liver disease and the development of skin cancer. CONCLUSION: Contrasting with previous data of the literature, our findings suggest that, for a similar follow-up time, the risk of skin cancer in LTR is comparable to that of kidney transplant recipients.
Subject(s)
Liver Transplantation/adverse effects , Skin Neoplasms/etiology , Carcinoma, Basal Cell/etiology , Carcinoma, Squamous Cell/etiology , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
El citomegalovirus es un patógeno oportunista que frecuentemente afecta pacientes con compromiso inmunitario. Diferentes órganos pueden resultar afectados, y las lesiones en piel son raras e inespecíficas. Se presenta el caso de un hombre de 70 años con diagnóstico de leucemia linfocítica crónica e infección por citomegalovirus con manifestaciones cutáneas.
Subject(s)
Cytomegalovirus , Cytomegalovirus Infections , SkinABSTRACT
La paniculitis citofágica histiocítica es una rara alteración mediada inmunitariamente, que puede tener un curso indolente o ser fatal cuando se acompaña de síndrome hemofagocítico. Presentamos el caso de una mujer con paniculitis citofágica histiocítica asociada a leucemia mieloide aguda.